Clinical and biomechanical behavior of a platinum-chromium stent platform in a large all-comer single-center population: insights from the Novara-PROMETEUS registry
Alessandro Lupi, Italo Porto, Andrea Rognoni, Maurizio Lazzero, Rossella Fattori, Rosario Parisi, Giovanni Luigi De Maria, Angelo Sante Bongo, Imad Sheiban, Leonardo Bolognese, Pierfrancesco Agostoni, Gioel Gabrio Secco, Novara-PROMETEUS (Platinum ChROMium Everolimus EluTing StEnt SpontaneoUs RegiStry) Investigators, Alessandro Lupi, Italo Porto, Andrea Rognoni, Maurizio Lazzero, Rossella Fattori, Rosario Parisi, Giovanni Luigi De Maria, Angelo Sante Bongo, Imad Sheiban, Leonardo Bolognese, Pierfrancesco Agostoni, Gioel Gabrio Secco, Novara-PROMETEUS (Platinum ChROMium Everolimus EluTing StEnt SpontaneoUs RegiStry) Investigators
Abstract
Aims: Longitudinal deformation has been described as a new complication affecting new-generation thin-strut coronary stents. Benchmark tests have suggested that the platinum-chromium (PtCr) Element coronary stent platform (Boston Scientific) might present increased susceptibility to this complication. Our study assessed the incidence of longitudinal stent deformation in a large single-center study population.
Methods and results: A total of 337 consecutive Promus Element PtCr stents deployed in an all-comer population underwent quantitative coronary angiography (QCA) analysis. Postdeployment QCA measured/nominal stent length ratio (SLR) was considered as a surrogate estimate of longitudinal stent deformation and averaged 0.95 ± 0.04 in the entire population. This small postdeployment reduction of stent length had no clinical relevance, leading to 3 cases (0.9%) of trivial geographical miss, which did not require further interventions. Plaque prolapse through the stent struts was observed in 19 cases (5.6%). Only 1 case of typical "concertina" effect (0.3%) complicated an ostial stenosis treatment requiring deployment of a second stent, while in 3 cases (0.9%), stent struts adapted to severely tortuous and calcified vessels mimicked longitudinal stent deformation, without further complications. Multiple regression analysis demonstrated a significant correlation between need for predilation and lower SLR values, while postdilation independently predicted higher SLR.
Conclusions: Systematic QCA analysis of a large single-center all-comers PCI population treated with PtCr stents failed to detect any clinically relevant longitudinal stent deformation. Complex lesions needing predilation were associated with a reduced SLR; conversely, postdilation was associated with QCA stent measures close to nominal. Clinicaltrials.gov ID: NCT01759719.
Source: PubMed